Provider Demographics
NPI:1376881557
Name:COOK, CAROLYNE MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLYNE
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAROLYNE
Other - Middle Name:MARIE
Other - Last Name:HAVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 3021
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-7816
Mailing Address - Country:US
Mailing Address - Phone:913-588-6122
Mailing Address - Fax:913-945-8225
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 3021
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7816
Practice Address - Country:US
Practice Address - Phone:913-588-6122
Practice Address - Fax:913-945-8225
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily